Evidence Based Physical Therapy Articles-Manual Therapy

Posture in the Management of Musculoskeletal Pain

Michael Rinaldi, PT, OCS

In treating musculoskeletal problems, primarily neck pain and back pain, it is often a common occurrence to have patients come in, particularly women, and say at some point during the exam “I know I have bad posture.”  Or they may say something like “I know I should have better posture” or “I know I need to be working on my posture.” 

Sound familiar?

As therapists early in physical therapy school we’re taught about the importance of posture.  Most of us are exposed to the work of Florence Kendall at some point in our physical therapy curriculum.  I recall meeting Florence Kendall in 1992 and somewhere in my library have a first edition book which she had autographed (This was even before my time).  

I’m sure any therapist can recall having to do lab drills consisting of lining up fellow classmates against a plumb line and looking for asymmetries in each other’s posture. 

Is this what are we trying to do when looking at a patient’s posture?  Are we just looking for asymmetries simply because we were taught to do so in school?

Some therapists simply note what they see and do nothing about it.  Others may do some simple stretching or address it with some type of exercise thinking that if they strengthen a certain muscle it will magically correct the patient’s posture.  Others make it an absolute crusade to change what may in effect be a patient’s normal genetically-inherited protoplasmic composition. 

In reality posture needs to be placed in relative context to what is going on with the patient.  For instance, if the patient is suffering from shoulder impingement, one needs to take a look at what type of a posture is occurring at the cervico-thoracic junction (forward head position), the scapula to determine its positioning relative to the rib cage, and any thoraco-lumbar spine issues that may be present.  One may also want to look to see if there is a forward shoulder posture as well. 

In this context one is looking at whether or not posture can give us clues as to potential movement impairment problems may be present (Sahrman).  If identified one can then address those things on a logical basis. 

The biggest mistake is to address posture solely for the sake of addressing posture under the guise that a patient’s posture must be perfectly symmetrical.  Then making the attempt to “correct” subjectively faulty posture as part of a care plan with the assumption that postural symmetry or subjective “correctness” will lead to functional improvement and/or resolution of symptoms. 

This is simply not true. 

Read further to discover one reason why.

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